THE HEALTH WEEK. T HE members of the Agenda Club are
to be congra tn. hated on having originated the scheme of a " Health Week," by which is meant, in the main, a week which should be devoted to the public advocacy of simple rules for preserving health. The week just ending is the first occasion for giving effect to this idea, and it is intended to repeat the experiment regularly year by year. The week b an with sermons in a large number of churches on the importance of cleanliness and of observing other obvious precautions for the maintenance of health. Later on in the week lectures were given on successive days in forty different towns, some of the lectures being illustrated by cinematograph pictures. No doubt the number of persons directly reached by these methods has been small in comparison with the total population, but the great advantage of even this first attempt at a National Health Week has been the advertisement of the cause. Many people who had no opportunity of going to the lectures, and who missed the sermons, have read in the newspapers that a Health Week was in progress, and their minds have been directed even if only for a brief time to the possibility that the health of the nation may be improved by the observance of reasonable and simple precautions. In the well-to-do classes most of these precautions are now fairly well understood. The importance of cleanliness does not need to be preached to the upper and middle classes and more prosperous artisans, and the importance of fresh air is equally well understood in theory, though in practice it may be doubted whether the gospel of the open window is as fully observed as the rules of health require. Rumour says that even in Harley Street in the early morning more than half the windows of the bedrooms occupied by the medical faculty will be seen to be closed. This is not duo to any lack of faith in the value of fresh air, but to the continuance of old habits. Some observers even claim that they can tell the age of a doctor by noting whether the windows of his house are habitually open or shut. The doctrine of the open window is in fact a comparatively modern discovery. One of the earliest advocates of this doctrine was the late Dr. MacCormac, who first made his reputation in Belfast. In the 'sixties and 'seventies Dr. MacCormac published pamphlets advocating fresh air as a preventive of con- sumption. His theory was that phthisis was generated by breathing air that had been breathed before. He pro- mulgated this theory with great vigour and insisted that the remedy was to be found in the open window. For example he writes : " The window closed by night entails greater destruction than sword or gun," and, again, he points out that "the atmosphere of the vilest slum admitted freely into the sleeping chamber is preferable to the atmosphere of a bedroom in a palace from which the outer air has been excluded." He allowed his own son to sleep between the open door and open window, with the snow drifting in over his bed. His theory of the origin of consumption has, of course, since been disproved, but his conclusion that the absence of fresh air encouraged consumption is now universally accepted. Yet when this conclusion was first put forward it provoked indignant denunciations from many of the loaders of the profession. That doctrine still needs to be taught throughout the length and breadth of the land. Constantly one finds people living under conditions where they might enjoy as pure air as any to be had in the world deliberately depriving themselves and their children of this almost priceless advantage by keeping the windows of their homes hermetically sealed. Some blame, it may be added, attaches in this matter to landowners and to architects. The landowner, for the sake of economy, will often leave an old cottage fitted with windows which are not made to open ' . while architects, for the sake of what they are pleased to call " art," will frequently in new houses construct windows so small that they allow insufficient ingress for air. In this connexion we should like to press upon all wealthy residents in rural districts the duty which lies upon them to do something to improve the housing accommodation of their poorer neighbours. There are very few villages in the kingdom where the supply of really comfortable and healthy homes is equal to the demand. It costs less to build two good workmen's cottages than to maintain a fair-sized motor car for a single year, but the cottages provide comfort and health not for one year but perhaps for a century for two whole families. In some districts a rent can be obtained which will give quite a reasonable return on the capital invested. In other districts, where wages are by custom too low to enable the labourer to pay an adequate rent, a wealthy resident who builds a cottage of which he is not himself ashaaned must not expect to obtain a commercial return upon his outlay. He must find his return in the satisfaction which every honest citizen ought to feel in contributing something to the permanent well-being of his country. Nor can it be objected to such a method of spending money that it tends to pauperize the recipient. On the contrary, there is nothing which so greatly tends to raise the general standard of comfort and self-respect as the provision of good housing accommodation ; while the workman, as a rule, knows so little of the economy of house-building that even if the house is let to him at considerably less than cost price he is not aware that he is receiving charity.
Needless to say, the provision of good house accommoda- tion presupposes the provision of facilities for cleanliness. These are in many cases, especially in the country, still shamefully neglected. In many country places cottagers have to fetch their water from such a distance that cleanli- ness becomes a costly luxury. In towns the conditions, at any rate as regards houses occupied by the better-class artisan, are more satisfactory, and in some northern towns it is stated that new houses cannot be let unless they con- tain a bathroom. But there still remains in all our towns a largo residuum of the population living under conditions where oven if the will for cleanliness is present the oppor- tunities are so meagre as to make the practice of it extremely difficult.
There is another consideration which applies to practi- cally the whole body of manual workers in the country. With rare exceptions manual workers, even when they have been engaged on extremely dirty work, proceed from their work to their homes in the clothes in which they have been working. This is primarily, perhaps, due to the absence of facilities in the workshop for washing and changing ; but even where such facilities have been created by the more public-spirited employers the workmen have shown little eagerness to take advantage of them. This appears also to be the case in Germany and Switzerland, where many employers have made provision for the convenience of their workpeople far in advance of what is to be seen in this country. For example, a well-known Swiss firm of engineers has provided shower-baths, simple and economical in construction, but highly efficient, so that every workman may have a complete bath on leaving his work. But here, again, only a small number of the workmen make use of these facilities. The truth is that on this point working- class public opinion rather tends to condemn the man who changes his clothes as being somewhat of a dandy. In the United States, on the other hand, working-class public opinion requires the workman to get into decent clothes as soon as he has finished his work. It will be interesting to see what happens with regard to the clause in the new Coal Mines Act which requires provision to be made for washing and changing at the pit-mouth. The matter is one to which trade unions might profitably devote a good deal of their energy. The social status of the manual worker cannot be very greatly raised so long as he continues to go from his work to his home in clothes which make him offensive to his neighbours.
This brings us to the point that national progress to a higher condition of health must depend upon public opinion, and the special value of the work undertaken by the Agenda Club lies in this, that it is an attempt to educate the whole nation. That much also can be done for the promotion of health by the existing public health authorities, and possibly by the new Health Committees of the National Insurance Act (if that Act ever comes into operation), there can be no doubt. Indeed, much already has been done by public authorities. But in the long run the Government authorities of a country cannot move very much in advance of the public themselves. It is the people who have to be taught how to make them- selves healthy, and the Health Week now coming to an end is an excellent device for popularizing this conception. While dealing with the Health Week we should be making a most serious omission if we forgot the very important interim report of the Committee on Tuberculosis, presided over by Mr. W. Astor, which appeared in Tuesday's papers. The Committee report that under the Insurance Act a sum of about £880,000 a year will be available for attacking the problem of tuberculosis, in addition to about £58,800 a year for research, and a capital sum of one and a half millions for sanatoria. The general principles advocated by the Committee will com- mand universal assent. They assert, among other points, that any successful scheme must be available for the whole community, and that an essential feature of it must be a, definite organization for the detection of the disease at the earliest possible moment. Mr. Astor's Committee therefore recommend the provision of two closely connected units, namely a system of tuberculosis dispensaries and a system of sanatoria. The former will act as "centres of diagnosis" and clearing-houses for the various forms of the disease, and from them patients will, if necessary, be drafted into the particular institution suited to their case. With regard to administration, the Committee are of opinion that, " having regard to the different classes of institution which are required, to the variety of the cases to be dealt with, and to the proper organization of comprehensive, efficient, andeconomical schemes," the unit area should be the county, or in some cases a group of counties, and that the county councils should be primarily responsible. With the general features of this scheme we find ourselves in com- plete agreement, but we cannot help expressing a, hope that every possible effort will be made to use the very large sums involved economically and efficiently. It would surely be advisable to have some central authority for inspecting and checking the administrative work of the county councils, We know of no better means for doing this than the system of the " grant-in-aid," which has worked so satisfactorily in the case of the Police. It should not be difficult to devise some machinery which should make the grant to the local authorities for tuberculosis purposes dependent upon their efficiency in administration.
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